This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 6 February 2010

I see Creepy People.

Or crazy, stupid creepy people who watch to much TV perhaps.

People are generally ignorant about things in which they have no personal experience.

Even the most open minded person who is aware of his own limitations will lay into medical and nursing staff like a rabid dog. I put this down to fear, the inability to deal with their mortality, their loved ones mortality, and the loss of control that all these things bring. Most people have no understanding about what a nurse is, or what she does, or what she has on her shoulders. But that does not stop them from being a monday morning quarterback, ready to tear her to pieces. The mental guidlines they use to measure their nurses (and doctors) by come from years of fictional and incorrect medical dramas that they have viewed on TV.

On TV even the dying patient looks lovely and calm...because the nice nurses and doctors made her look that way.
On TV nurses and doctors have lots of breaks to chat. On TV a confused patient can be settled down with a kind word. On TV the patient has his own crew of multiple nurses and doctors, around him at all times. On TV the nurse will stop and attend to you as soon as you shout nurse because that is what she is there for, it's not like she'll have other patients sicker than you. On TV the hospital provides that staff with enough linen to change the beds every day.

On TV a trauma patient looks beautiful after falling out of a plane and survives horrific injuries because the doctors and nurses decide to make her look beautiful and make her survive. On TV elderly people are never violent or aggressive. They never attack other patients or rip their tubes and lines out, as well as the tubes and lines out of other patients. If they do behave like that, the nurse (or the doctor) is shown sat at their bedside, holding their hands, because on TV doctors and nurses are not being rushed between multiple patients as if they are working on an assembly line. On TV if a patient dies it is because the doctors and nurses are crap, incompetent or evil.

Now de- program yourself.

We deal with these kinds of attitudes on a day to day basis. You wouldn't think that people are so stupid but they are indeed. Everyone has stereotypes about lawyers, stock brokers, and McDonald's burger flippers. But that is nothing compared to the bullshit they believe about medical care.

Last week I took over from another RN on the shift after hers. On her day shift her youngish patient crashed and survived but she needed to one to one him for 6 hours until he went to another facility. In real life these things occur all the time, and the nurse is not given another nurse to care for her other patients. That means that they are without a nurse until the their nurse dumps her critical patient on someone else. As she is walking back and forth to the medication room to get additional supplies for her patients she cannot, under any circumstances stop and get commodes or do a drug round or any such thing. The healthcare assistants are around, trying to help out the best they can. But they cannot do meds, or doctors orders, assessments, dressing changes, discharges etc. This means that the other patients are without that stuff for as many hours as it takes for the nurse to lose her critical patient. The nurse cannot control this in any way shape or form.

I took over from Rachel and my first job was to run to her other patients who hadn't actually seen a nurse all day. The critical patient was now gone. I caught up on the other patients care etc etc. All I got from them was

"oh you are so nice compared to that horrible Rachel this morning, who ignored us completely"

"Oh you are so nice, that Rachel hates old people"

"That incompetent Rachel didn't bother to bring my tablets on time"

"That horrible nurse Rachel didn't change my dressings"

"Thank god for nice nurses like you Anne, that horrible Rachel has no compassion"

"I am going to report that horrible Rachel, I shouted out for her to bring a commode and she ran right past me and told another girl to do it (Rachel was running for a bag of geloinfusion and the other girl was a health care assistant who could not help out with the critical patient).

It didn't matter how many times I explained that Rachel is actually an excellent nurse who was tied up with a critically ill patient that she could not allow to die. It didn't matter how many times I explained that the reason I was able to care for them right now was because there was no longer a critically ill patient on the ward. It went right over their heads.

Now I can certainly understand these patients being distressed by their lack of care. I would be distressed as well, and angry. But why would they assume that a nurse with multiple patients would be able to meet all of their needs instantaneously, at the drop of a hat? What causes them to classify a nurse who doesn't do this as "lacking in compassion". Even when they are told that their nurse has 15 other patients, that one of them is trying to die on her, and that management refuses to staff the ward with actual nurses as they did years ago even though the patients are sicker now............the average lay person still does not get it.

This is why we lose nurses.

The next day I was working with a lovely health care assistant. She is 19 weeks pregnant and was scheduled to work an 8 hour shift. We had no care assistant for the afternoon so she stayed on and in total did 14 hours. Bless her heart. But even so we were struggling. The afternoon shift for 30 patients consisted of myself, another RN and this pregnant care assistant for 30 heavy and complicated patients.

Their families don't want to be bothered pushing their service providers to hire nurses, they don't want to understand what intentional short staffing by management does, they don't want to be bothered backing the nurses up when they blow the whistle on short staffing but boy oh boy do they love to lay in to the nurses for not providing one to one care.

If you want someone to always stay with your mother while she is on the commode, or always have her pain medicine on time, or be there instantly when she needs the loo then what you want is indeed one to one care. You don't want your mother's nurse to have any other patients. The nurse has no right to control how many patients she has nor can she control what is going on with them. She cannot even control how long she spends with them at a time, as all that depends on her other patients. To you, this seems to mean that the nurse "lacks in compassion". I don't think it's the nurse who lacks in compassion, not by a long shot. I think it is the public. Mentally, they cannot deal with the reality of sickness, death and health care economics, so they lash out at the soft targets. Nice.

Ellen, the lovely pregnant health care assistant went to hour 11 without a break of any kind or food and fluids. At hour 11 I told her to sit her ass down and have a break. There were lots of things going on in the ward, we are always outnumbered by call bells and patients needing help. But I didn't need a collapsed pregnant health care assistant on my hands as well. The hospital will deduct 1.5 hours out of her pay for breaks whether or not she takes those breaks. She was not going to take it. I made her take one. As I said before, I wasn't in the mood to deal with a collapsed and pregnant member of staff. She finished what she was doing and went to the office with a mug of tap water and some dry crackers. She didn't feel that there was anytime for her to disappear off the canteen.

Enter Simon. He is the son of a frequent flyer patient of ours. He likes to follow the staff around taking pictures on his phone. If a patient is ringing a call bell he stands there with his watch and counts how long it takes for the bell to be answered, then he goes apeshit on the staff.. He doesn't bother to think about what the staff are actually right in the middle of at that moment. He jots everything down in the notebook and shouts at the nurses. To Simon, anyone in uniform is a "nurse" and she is a nurse who doesn't want to take care of patients. He tries to take pictures of patients so he can sent them to the papers and "shop us" for neglecting everyone. If he sees a confused patient shouting out he demands that the staff "do something to stop her confusion and help the poor woman right now dammit". Simon, there is absolutely nothing that a nurse can do to stop a patient from being demented and shouting out. Nothing. Nothing. Nothing. Nothing. Even if I didn't have other patients who need things at this moment. Simon is like our wards own little daily mail police officer. We don't have security or anything, we can't kick him out, we just have to put up with it.

As soon as Simon saw Ellen head into the office with her crackers he was straight there, camera in her face, taking pictures of the "lazy nurse who is stuffing her gob whilst patients need help". I had words with him, explained that Ellen was not a nurse, that she has put in a long day trying to help these patients and that she is expecting and needed to stop and eat. He laughed at me and shook his head.

Simon is not just one guy, he is many. We are getting more and more of this. Simon himself is unemployed. I doubt he ever went as long without food, working his tail off, as Ellen was doing. Pregnant Ellen took a grand total of 10 minutes out of a 14 hour shift to stuff some crackers and tap water into her mouth. And she was called lazy. Only nurses and health care assistants could work a 14 hour day in horrendous conditions where they can barely function and still get called lazy by an unemployed 40 year old healthy (physically) male. The other nurse and I skipped our breaks completely but even that did not get us off of Simon's hook, nor were we able to feed any patients or answer call bells quickly.

We are getting bombarded with Simon types and I don't really know what to do. He wouldn't behave this way in a supermarket, or a bank. If he did he would get kicked out.

What can we do about people such as Simon?

What can we say to people who think that there elderly mother was left on a commode because the nurse is "cruel".

Why do they not think about what else might be going on?

It's fucking creepy if you ask me.

I always find it very offensive that people will make these kinds of judgement calls about nurses without having any kind of idea what other things the nurse has on her shoulders at that moment in time. We know that lay people have no idea of the function of a nurse.

What about people who shout out a nurse whilst she is in the middle of slowing bolusing an IV drug and demand that she stops what she is doing and bring granny a bedpan?

Visitors do this and then run down to complaints whining about being ignored by the mean nurse who left crying granny without a bedpan. I know if I am bolusing a drug I will blank anyone speaking to me until I am done with what I am doing. I made a mistake once because relative rushed me. They show no respect for the nurse, or the patient receiving the drug that will kill them if pushed in too quickly by a rushed nurse. It is truly diabolical to start yelling nurse at anyone walking past in uniform and expect them to be able to stop what they are doing immediately and attend to you. They are in no position whatsover to just drop the ball like that.

How can we make these people understand why these things happen?

Why do we get no back up from the Hospital chiefs?

Or the Media?

Or our Nurse leadership?

Or the Doctors?

They have all jumped on the "The nurse can do everything perfectly at all times for 30 patients all by herself and give them all one to to one care on another person's terms and timescales...and if she doesn't, she is "lacking in compassion" bandwagon.

The terms and timescales of the patients, visitors, managers, doctors etc are a mute point anyway because they don't understand what else is going on in that ward. No nurse on a large short staffed ward can take all the time with one patient that he needs, without bringing harm to another.

I don't get it. But I know it has a lot to do with people not being able to deal with the fear and loss of control that a hospitalisation brings. I used to have sympathy. Now I am sick and tired of being the kicking bag for their dysfunctional coping mechanisms and their inability to deal with the realities of sickness and death.

It's never pretty. Sickness and death, old age, ischemic legs, loss of independence, infected wounds, sepsis, pulmonary oedema, death etc etc is always UGLY and HARSH. Even with the best staff on the case. Two litttle 5 foot tall nurses are never going to be able to move a 15 stone combative patient gracefully. We cannot stop people from falling. We cannot force people to eat.

29 comments:

We need to team up. There are lots of us blogging about these issues, doctors, nurses, patients, but apart from the odd few like Dr Crippen we're only reaching relatively small audiences. Organising ourselves into a group would make one strong voice that would be much more difficult for the politicians to ignore or manipulate into their own spin.BendyGirl

I'm a nurse. When I was a patient in hospital, I rarely saw my nurse in our bay, as all of us were quite well. I understood why our nurse wasn't very visible, but the other patients were very vocal in critising her for not being around enough. It was terrible listening to these relatively healthy patients slagging the nurses off for being lazy and uncaring etc. They didn't notice the stress and exhaustion in here eyes like I did. I wanted to tell them all to F*** off, on the nurses behalf.

I think slowly, that you are making an impact. People are listening to you. I see comments from hospital docs who are in agreement with you.

It is unfortunate that the general public do regard Causualty and Holby City as real life. This is how hospitals should be. Doctors and nurses in abudance at all times on the ward. But it is not real.

Then we have the wonderful media who report how life really is on the wards, but fail to inform of the reasons why. Nurses are scapegoated and as you rightly say, no one, but no one, defends nurses.

I feel that The Patients Association, as well as the media, will be why "Simon" is logging and photographing all and sundry. The Patients Association, unknowing to itself, is perpetuating bad practing, bad staffing, etc., by joining the blame culture. I wish they would read your blog!

There will always be arseholes like Simon, but at the same time, patients and relatives will not realise apparent poor patient care is down to dire staffing levels. How can they know? They only know what they read in the media, whether factual or not.

If I saw a visitor taking photos of other patients i would have him removed from the ward permanently. Let him go to the fucking press. If he were to come and take photos of me while I was on my break I would have took his phone off him and smashed it into pieces. It amazes me how much shit nurses end up having to take off members of the public, be they patients or visitos. I have seen a visitor become agressive towars the sister because he didnt want his relative discharging because they couldnt be bothered to go to their GP's to have sutures removed in a week, why cant she justv stay as an inpatient. I have had a patient request to be moved back to ITU because the nurses there spent more time with him and he was reviewed by a consultant several times a day. People have odd expectations to say the least. It is amusing to see the look on peoples faces when I tell them that around 80% of inpatients do not survive cardiac arrest, they expect it to be like holby, one cycle of cpr and a quick zap off the defib and theyre back in the room.

It can be done. The head of security told me that the hospital is Trust property and that visitors have no right to enter - they are allowed to do so on the understanding that they behave themselves. One husband was intimidating the nursing staff and was told he was only allowed to speak to one particular consultant. When he made an intimidating statement to the nursing staff, and once when he tried to talk to me (I'm a doc) to tell me that he didn't want his wife treated, we called security who escorted him off. He was removed every day. Apart from the days when his wife didn't want to see him when he wasn't allowed on to the ward. I had to ring security for the nurses as they seemed to think that they should just put up with the abuse. Sadly, management do not back nurses up. Zero tolerance of violence to NHS staff is a joke.

Our hospital doesnt have security.. we have to call the police for any support and most nurses are reluctant to do it. I got punched in the face by a patient once (i'm a nurse), and my manager told me to just forget it. The police were called due to the patients aggressive behaviour, the police wanted me to press charges but my manager said "it wansn't worth it". Nice to feel safe at work, and valued by management.

Working in a large-ish ICU in a city we have panic buttons under all the nurses stations and to be fair, security take them seriously. Having worked in ED I am pretty good at reading people so have only come to grief a few times in my career. The tosser with the mobile phone- I would ask him politely to remove himself/it and if this failed I would call security AND report him to the local plod for using a camera within an area full of vunerable people. Or even better, accuse him of taking inappropriate pictures of underdressed patients/hanging around the nurses toilets (play the pervert angle very loudly). Most bullies hate to be shown up. Being only a tad over 5 foot myself, I have often struggled with larger patients. The bariatric beds make my job even harder as once a patient is in them I need a stepladder to reach them. Just this week i received a complaint from a family member that his morbidly obese girlfriend was embarressed to be on this bed and that it takes 6 of us to move her. He wanted her squeezed into a normal bed and only have 2 of us to move her like the patient in the next bed. I pointed out that this would mean that she didn't get moved at all and would develop a sore. He was adamant that we were victimising her and were being lazy asking for so many nurses each time she needed to be moved/sat up in bed etce tc. I gave up in the end.

Panic buttons would be handy, but security are not the best of people at times. At uni one of our lecturers told us we would be better off calling the police if a violent incident was happening as they are fully trained to deal with it and if they get a call from the hospital they tend to get there sharpish as I have seen when on nights in the ED. When we have patients that are combative I get asked to help out with them being a bloke, I don't mind and understand that patients can't help it, its just when spoiled Jeremy Kyle guests kick off on the ward because they are not getting their way, using lines like, "what the fuck do you know, youre only a nurse".

I think this Simon guy is one of those cases where management may just be useful for once. It may be that this is actually a criminal offence and they would dearly like to be able to stop this as if anything bad came out it would reflect badly on the hospital (for a short time at least until the blame is diverted to the nurses). I do like the pervert line that should worry him. It's a pity you don't have security. They are often big, quite nice guys. They are at their best when something getting a little tense and just say "you alright there nurse/doctor".

Our only security guys are the porters who are always to busy and the doctors.

Even the meanest doctor will jump to a nurse's defense if she is being battered. I saw a surgical patient start beating a nurse once, and about 4 doctors saw it too and they jumped the guy. They really let him have it and kicked him off their list.

Of course not all relatives are creepy. As long as you talk to the nurse as if she is a human being we think you are nice, even if you are raising a concern or a complaint. And of course some nurses do just suck. Most of them are busting it though, and failing their patients. We can't weed the bad out if the good ones are failing.

I worked yesterday and it was awful. Truly awful. Wouldn't have made it out of there alive if we didn't have nice, supportive. relatives up there that day.

I was on the ward alone not so long ago and a man was freaking the fuck out on me because I couldn't lift his 19 stone relative up the bed on my own!! It was so funny, in his mind he thought that I just didn't do it because I wanted to leave her uncomfortable. Hello!! I am very petite and weak!! So I hear ya.

Anne Did you ever have the meeting with the top guy that you had mentioned - he didnt show up for the prev scheduled one? You have my sympathy - are you coming back to USA and which State will you be in?

"Only nurses and health care assistants could work a 14 hour day in horrendous conditions where they can barely function and still get called lazy by an unemployed 40 year old healthy (physically) male."I believe this comment sums it up quite nicely. Next time you see Simon taking pictures, pull out your own cell phone and take a picture of him. I'll bet it will freak him out!

Anne, I think you should just call the police next time that man follows the pregnant HCA to the break room to harass her. She is pregnant and he is threatening her. He sounds like some creep who is going to go nuts at some point and hurt someone. And he is violating confidentiality by taking photos of other patients. You and the rest of the staff should not have to put up with that shit! Call the police next time and get him off your ward - preferably out of your hospital- if he's going to act that freaky!Casey in the USA

Oh, and by the way, it sounds like Simon could use a job! Why don't you hand him an application for a HCA position next time he is berating you and your colleagues and tell him, "We really need help here. We could use someone with your apparent expertise. Why don't you get a job here and help since you are obviously so fascinated by this work and have so much input to offer?" That might actually shut him up!Casey in the USA

And what did the news tell us today that the government are going to announce soon: one-to-one care for cancer patients at home! If they can't manage better than one to twenty on a ward how on earth will they manage THAT one?

I was caring for a huge, immensely strong patient whose behaviour was aggressive, not out of malice but confusion as a result of a brain injury. A new security guard appeared one day. He was small, timid, worried looking and very polite and deferential. He nervously enquired whether the patient was dangerous. I explained that the patient was confused due to brain damage, whereupon the patient suddenly gave a loud roar and tried to grab a heavy wooden chair next to the bed. I could see the intention was to hurl it across the room. The little security guy didn't 'get it' at all. In a soft voice he gently chastised the patient saying "now now, you mustn't be rude to the nice lady!" The "nice lady" bellowed "grab that chair" as she launched herself into the air in a flying rugby tackle that would have done the England team proud and just managed to pull away said seat in the nick of time, thwarting the patient who was trying to lob it through the nearest pane of glass. A disaster was thereby averted. I look back and laugh at this incident now but even though it was hair-raising it was nothing unusual, just a normal day on the ward really. The general public don't understand half of what nurses have to deal with. Incidentally the patient made a splendid recovery and was an absolute poppet, one of the sweetest people I have ever met.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.